For Medical Journals, A New World Online

By ERIC NAGOURNEY

Published: March 20, 2001

There was a time when the University of Zimbabwe could boast of subscribing to more than 600 different medical journals, a collection that made it a standout among sub-Saharan institutions.

Over the years, though, as resources shrank and the journals raised their rates with disheartening regularity, that changed. At the university's library in Harare, there are now subscriptions to about 170 medical journals. Librarians there have even taken away the racks on a wall where journals used to be placed.

That is not all bad news for this university and for countless other medical institutions and providers in developing countries. The racks on the wall have been replaced by computer terminals, and students and teachers have begun to use the Internet to gain access to the medical journals that gradually are making their way online.

''The B.M.J. has won our hearts because it's free,'' said Helga Patrikios, the medical librarian at the University of Zimbabwe.

The decision of the B.M.J. -- as the well-regarded British Medical Journal is known -- to make itself available at no charge on the Web is but one manifestation of the way the Internet is changing the multibillion-dollar medical journal business. The Internet has already altered how many journals operate, forcing most of them to put articles online. In the coming years, this could fundamentally change the face of the industry, with some midlevel publications facing the threat of extinction if they fail to adapt.

On another level -- and to the pleasure of many researchers, practitioners and medical schools in developing countries -- the democratizing effect of the Web has already had at least one benefit: the flow of valuable information making its way to poorer regions, once a trickle, is now a steady if still limited stream.

''It's what they call a disruptive technology -- it does sort of change all of the opportunities within the market,'' said Richard K. Johnson, enterprise editor of the Scholarly Publishing and Academic Resources Coalition.

The group was founded in 1997 by representatives of North American research libraries to try to break what they see as a stranglehold by the scientific, technical and medical journal industry.

For academics, publication in the ''right'' journals (think The New England Journal of Medicine or The Annals of Internal Medicine) can do much to assure tenure, and so they have abided by many publications' insistence that they say little or nothing about their work before it appears (lest the journal be scooped) and that they relinquish their rights to the material.

For doctors, the journals have generally been the only means to keep abreast of new developments in the field. And for libraries, journals have been the only game in town, so there has been little choice but to pay the $15,000 a year or more that some of them charge, to say nothing about paying for individual articles from past issues that they do not own.

But the Internet may undo in less than a decade what took three centuries to evolve. The talk among researchers these days is of e-prints, preprints and postprints -- all ways for researchers to make their own material widely available, at no charge, before or after it appears in a journal. Researchers also speak of PubMed Central and Biomed Central, potentially vast electronic archives of new and previously published articles available, again, at no charge. And, there is talk of boycotts of journals by researchers disturbed that the journals refuse to make the work freely available after a certain amount of time.

Few predict that any of the top-tier journals face a serious threat. But some believe that trouble lies ahead for many of the highly specialized midlevel publications with big price tags and small audiences. And virtually every journal, from the most obscure to the most prestigious, is being forced to create an online presence and to reconsider whether to make some or all of their material available at no charge.

Much of the pressure is coming from outlets like PubMed Central, a new archive created by the National Institutes of Health.

While the institute, a government agency, had long maintained a vast archive of journal abstracts that helped steer researchers to articles of interest, the goal of PubMed Central is to persuade medical publishers to post full-text archives on the site, where they will be made available worldwide at no charge. The publications decide how long to wait before turning the material over.

Some have rushed to do so; most have not. In either case, said Nicholas Cozzarelli, editor of The Proceedings of the National Academy of Sciences, ''It has forced the whole field, the whole publishing community, to move in that direction.'' The Proceedings was one of the first journals to join the initiative.

PubMed Central, the brainchild of Dr. Harold Varmus, the former director of the health institute, has provoked criticism in the medical-journal world. Dr. Marcia Angell, for one, former editor of The New England Journal of Medicine, has objected to early plans for the archives to print primary research that has not been reviewed by peers -- the cornerstone of any serious medical journal. Others have protested that they cannot afford to turn over material without compensation.

''The main issue is that content is our livelihood,'' said Dr. Margaret A. Winker, deputy editor of The Journal of the American Medical Association, ''and so to provide content free of charge can undermine the financial viability of the publications.''

JAMA refuses to discuss its revenues, and The New England Journal of Medicine stopped divulging revenue figures two decades ago. But by some estimates, its owner, the Massachusetts Medical Society, pulls in at least $20 million a year from the journal.

Dr. David Lipman, the director of the N.I.H.'s Center for Biotechnology Information, which operates PubMed, said medical journals should consider the archives an opportunity, not a threat. ''What we're basically saying here is, We're creating an archive if you want to give us your content,'' Dr. Lipman said. ''Put it here and we will make it available and safe.''

The goal, he said, is to get medical information to the places where it will do the most good, and to preserve it in a form that will make it readily available in the years to come.

''It's a very simple thing we want to accomplish,'' Dr. Lipman said. ''We want to make sure that this incredibly precious information is as available as widely as possible to everyone in the world.''

While PubMed Central is gradually winning over some journals, others are unconvinced. JAMA, which in the mid-1990's experimented with providing its articles free on its own Web site, now makes only part of its material available at no charge. It is about to start its own fee-based electronic archive service. The New England Journal of Medicine is also considering making its archives available online. And some major journals have already decided to make themselves entirely available online at no charge, among them the British Medical Journal.

This has been a welcome development at places like the University of Zimbabwe, although Mrs. Patrikios is among the many people to lament the ''digital divide'' that separates developing countries from the rest of the world.

Dr. Klara Tisocki, a professor of pharmacology at the university, said the Web had already made it easier to do her job, allowing her, for example, to get the latest information on administering drugs against the AIDS virus.

Still, while some major journals make themselves available selectively to developing countries, and say they are moving to increase those efforts, Mrs. Patrikios and Dr. Tisocki said much more needed to be done to make studies available.

Photos: Helga Patrikios, medical librarian at the University of Zimbabwe, says more needs to be done to make studies and publications available online. (João Silva for The New York Times)(pg. F1); Dr. Klara Tisocki, a professor at the University of Zimbabwe, helping Hercules Maguma, a medical student, with research on the Internet. (João Silva for The New York Times); PubMed Central, a new Internet archive created by the National Institutes of Health. (pg. F2)